Individual
MRS. ELIZABETH ANN SLATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, ATC, LAT
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 435-2626
Mailing address
8930 CROSIER LANE, FORT WAYNE, IN 46825
(260) 402-5204
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001428A
IN
Other
Enumeration date
07/10/2006
Last updated
03/23/2010
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